Provider Demographics
NPI:1952039919
Name:DOUGHERTY, AUDREY ANN
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ANN
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2627
Mailing Address - Country:US
Mailing Address - Phone:785-656-0301
Mailing Address - Fax:
Practice Address - Street 1:200 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KS
Practice Address - Zip Code:67665-2920
Practice Address - Country:US
Practice Address - Phone:785-483-3333
Practice Address - Fax:785-483-7631
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS144116163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice